WOMENS-HEALTH Messages for February, 1998: Re: adenocarcinoma

Re: adenocarcinoma

From: D. Ashley Hill, M.D. (anonymous@obgyn.net)
Sat, 14 Feb 1998 20:28:11 -0600 (CST)

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In reply to: laura: "adenocarcinoma"

At Fri, 13 Feb 1998, laura wrote: >
>Doctors,
>
>My LEEP conization showed adenocarcinoma in situ as well as carcinoma in
>situ on the surface on my cervix. I had clear margins.

This is a controversial topic amongst gynecologists, but you should know that adenocarcinoma in situ is a potentially dangerous situation. Simply put, there are two main kinds of cervical cancer, squamous (the most common type) and adeno (which means glandular). The squamous type occurs on the outside of the cervix, while the adeno kind occurs up inside the cervix (the endocervix).

Carcinoma in situ means that the abnormal cells have made it up to a layer of cells called the basement membrane, but have not penetrated it. This layer is only a few millimeters deep, but is very visible under the microscope. If the abnormal cells go even one cell futher past the basement membrane, it's called microinvasive carcinoma, and if it goes a few millimeters further, it's cancer. The treatment for carcinoma in situ and, perhaps, microinvasive cancer is either LEEP, or, more commonly, a cold knife conization done with a scalpel in the operative room. The treatment for microinvasive and invasive cancer is usually a radical hysterectomy or radiation therapy. Obviously, if you have to have one of them, it's better to have the in situ type versus the microinvasive or invasive cancer.

I doubt that anyone really knows whether LEEP procedures are adequate for adenocarcinoma in situ, but as long as the endocervical margins are negative it's *probably* o.k. However, only trust your doctor on this part, since he or she did the procedure and would know best. You will need frequent Pap smears, and probably colposcopies, as you have a fairly large recurrence risk. Some doctors would stongly recommend a hysterectomy after you are finished childbearing, but this would depend on the pathology report and your individual situation. As long as there is no recurrence during pregnancy, pregnancy should be safe.

Good luck, and please review this with your doctor.

-- Ashley Hill David Ashley Hill, M.D. Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, FL http://www.gate.net/~dahmd

I apologize, but I am unable to answer personal e-mail due to time constraints.

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